Fungal keratitis has a diverse geographic distribution and it is generally associated with ocular trauma, previous topical corticosteroid therapy and contact lens use. The purpose of this l-year prospective study was to identify the fungal species implicated in eye infections in our hospital and to determine antifungal susceptibility. Sixty-seven consecutive samples from corneal scrapings of patients in the Athens University Eye Center were cultured on standard microbiological media and stained smears were microscopically exarviined for bacteria and fungi. Yeast isolates were identified by the API ID 32C (BioMerieux) system and filamentous fungi were identified to the species level by a series of physiologic and biochemical tests. Minimum inhibitory concentrations (MICS) of amphotericin B, 5-fluorocytocine, fluconazole, itraconazole and ketoconazole were determined on casitone agar using Etest (AB Biodisk, Sweden).Gram-negative bacteria comprised the majority of the isolates (52). Candida albicans (3), C. ciferii (2), C. glabrata (1), Cryptococcus albidus (1), Aspergillus fumigatus (2), Acremonium strictum (1), Fusarium oxysporum (3) and Drechslera hawaiiensis (HeIminthosporium bipolaris)  were isolated. Two patients presented with both bacterial and fungal ocular infections. An increased MIC of amphotericin B (1 mg/ml) was recorded for Fusarium and Acremonium spp. A fluconazole MIC of 16 mg/ml (sensitive dose dependent) was recorded for C. glabrata. Resistance to fluconazole was recorded for all filamentous fungi.This is the first report of documented infective keratitis attributable to H. bipolaris. Accurate identification of fungal pathogens and susceptibility data are useful in selecting the appropriate systemic and topical antifungal chemotherapy for the management of ocular fungal infections. The clinical outcome of the cases presented here confirms that pertinent initial and maintenance therapy can help to avoid therapeutic penetrating keratoplasty.
Full conference title:
9th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 9th (1999)